Provider Demographics
NPI:1861261802
Name:JASTER, KRISTIN BENITA (COTA/L)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BENITA
Last Name:JASTER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 SUZANNE DR
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-9720
Mailing Address - Country:US
Mailing Address - Phone:810-285-6358
Mailing Address - Fax:
Practice Address - Street 1:1330 GRAND POINTE CT
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5502
Practice Address - Country:US
Practice Address - Phone:810-695-8920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI504979224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant